A few months ago, a young woman went to her doctor in New York. Her toenails had gradually blackened over six months and fallen off. No one in her family had abnormal toenails and she had no diseases, no injuries, nor a family history of nail disorders. During the tests it was discovered that she had a fish pedicure six months ago. The fish had caused injury to the nail matrix, which is the nail growth centre. This led to a nasty case of onychomadesis, in which the nail plates that make up the toenail halt production and separate, causing her nails to fall off. The condition can cause deep grooves to run horizontally across the nails, or large gaps where there is no nail. The case has been reported in JAMA Dermatology.
This is not the only problem fish pedicures have caused.
Fish pedicures have transmitted Staphylococcus aureus and mycobacteriosis infections.
Staphylococcus aureus is a bacterium which is a common cause of infections, that range from minor skin infections, such as pimples, boils, cellutitis, folliculitis, carbuncles, and abscesses, to lifethreatening diseases such as pneumonia, meningitis, osteomvelitis, endocarditis, toxic shock syndrome, bacteremia, and sepsis. An estimated 20 per cent to 30 per cent of the human population are long-term carriers of S. aureus. It can cause skin and softtissue infections, particularly when the skin has been breached. It can spread through contact with pus from an infected wound, skin-to-skin contact with an infected person, and contact with objects used by an infected person.
S. aureus can lie dormant in the body for years. Once symptoms begin to show, if untreated, the disease can be deadly. Once the bacteria have entered the bloodstream, they can infect various organs. Without antibiotic treatment, S. aureus bacteremia has a fatality rate around 80 per cent. With antibiotic treatment, case fatality rates range from 15 per cent to 50 per cent depending on the age and health of the patient – but the bacterium is now almost antibiotic resistant.
Mycobacteriosis is a chronic disease that occurs in fish reared under intensive conditions. Temperatures between 25oC and 35oC are ideal for the bacteria.
In the last decade there has been a steady increase in the frequency of Mycobacterium marinum infections in cultured fish, and human cases associated with fish aquaria have been seen all over the world. In fish, transmission can occur by consumption of contaminated feed, aquatic detritus, or entry via injuries, skin abrasions or external parasites. In humans, breaks in the skin serve as an entry point for the organism during contact with contaminated water sources, or infected fish and injury from fish fins or bites.
Mycobacteriosis infection most commonly manifests as a skin disease. Lesions tend to be noticed two to four weeks after exposure to the mycobacterium. The lesions swell and develop into ulcers which persist for months. In some instances, infection spreads to the lymph nodes. The skin, kidney, and liver are the main body parts affected in both fish and humans.
FISH PEDICURE CAN CAUSE DEADLY HARM
Diagnosis can be difficult and is often delayed, and by then the infection has spread, causing considerable damage to tendons and bone. Deep infections typically require both antibiotic and surgical treatment. Skin lesions can be chronic and leave scarring. Deep infections can lead to the loss of joint mobility, and severe cases may need amputation.
I had written about the dangers of fish pedicures two years ago, but India has still got dozens of parlours offering the service. I have just returned from Goa where the main tourist areas have small shady shacks advertising fish pedicures.
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